Anatomy of Healthcare Systems

Overview of Healthcare Systems

• Understanding healthcare is essential before attempting to make changes.
• Healthcare systems consist of four main constituents:
  • Government
  • Insurers
  • Patients
  • Providers (doctors, healthcare professionals, hospitals)
• Interactions between these constituents vary by healthcare system.

Factors in Healthcare Models

• Number of Sources of Coverage
  • Single-payer model: one source of coverage.
  • Multi-payer model: several sources of coverage.
• Source of Coverage
  • Government (single-payer) vs. Private insurance companies (multi-payer).
• Source of Funding
  • How governments and insurance companies are funded.
• Sector Responsible for Delivering Care
  • Private vs. Public sector.

Nationalization vs. Privatization Spectrum

• Nationalization: 100% government funding and delivery of care.
  • Pros: greater accessibility, lower costs, reduced admin complexity.
• Privatization: 100% private funding and delivery of care.
  • Pros: less regulation, more innovation, greater freedom for physicians.

Global Healthcare Models

1. Beveridge Model (UK)

   • Government funds and delivers healthcare.
   • Public delivery: government-owned providers.
   • Universal coverage, potential risk of overutilization.

2. National Health Insurance Model (Canada)

   • Government-funded, privately delivered care.
   • Patients choose private providers, greater freedom for doctors.
   • Universal coverage, simpler care delivery.

3. Out-of-Pocket Model

   • Absence of formalized healthcare system.
   • Citizens pay directly for care, limited access for the poor.

4. Bismarck Model (Germany)

   • Privatized system, insurance linked to employment.
   • Funded by payroll deductions.
   • Intended universal coverage, criticism for gaps during unemployment.

U.S. Healthcare System

• Mix of different systems:
  1. Veterans (similar to Beveridge model).
  2. Citizens 65+ (Medicare, similar to National Health Insurance model).
  3. Uninsured (lack universal healthcare, risk of financial ruin).
  4. Employer-sponsored insurance (Bismarck-like, but more market-driven).
• Criticism:
  • Insurance tied to employment.
  • Nonprofit requirement absent.
  • High administrative expenses due to insurer-provider battles.

Key Takeaways

• U.S. system is the most privatized and market-driven among developed nations.
• Other models offer variations in public vs. private funding and delivery.
• Each model has pros and cons related to accessibility, regulation, and innovation.

Conclusion

• Join the next part of the series to explore which country has the best healthcare system.